| NPI | 1457628117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEE FIORE Owner/President 904-646-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL CH 4913) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |